If you’ve ever experienced vaginal pain and irritation, but your doctor couldn’t diagnose you with a specific condition, you’re not alone. You’re probably suffering from a common condition called dysesthetic vulvodynia.
What is dysesthetic vulvodynia?
Dysesthetic vulvodynia, is the most basic terms, is vulvar pain, burning, and/or irritation without any known cause. Dr. Andrew Goldstein, an expert on this condition, describes dysesthetic vulvodynia: “The pain is generally non-provoked– there is pain without any contact. It is usually generalized to the entire vulva, but sometimes can be located in one area. The cause of this disorder is unknown.” In other words, the pain exists without any sort of stimulus. It’s a constant burning sensation that is unprovoked.
What causes this condition?
According to Goldstein, the nerves in the vulvar tissue are damaged and there is usually a pelvic floor dysfunction to magnify the pain. This nerve pain can initially be brought on by a variety of sources, such as stretching the nerve, allergic reactions, persistent infections, or any trauma to the vulvar region. Once the nerves are damaged, the chronic pain remains, even when the original source of pain is long gone.
It may not make sense for the pain to remain once the original trigger is gone, but Goldstein explains: “There are pain nerve centers in the pelvis, spine, lower parts of the brain, and the cortex of the brain. When these pain centers get persistent signals, they get more sensitive, so almost all sensations are then perceived as pain. . . women with central sensitization experience pain more easily.”
Another part of the equation that factors into dysesthetic vulvodynia is a pelvic muscle dysfunction. As a reaction the the pain, the muscles of the pelvic floor tighten, which then decreases the blood flow through the muscles. This decreased blood flow means less oxygen, glucose and nutrients flow to the pelvic floor muscles and the vulvar tissues. Lactic acid accumulates so that the muscles become tight and weak, causing additional pain to the area.
How is it treated?
Dysesthetic vulvodynia is a condition that few family doctors and even gynecologists are aware of. Relatively little research has been conducted on this condition, and many doctors have never even heard of it– let alone understand it. Finding a doctor who understands dysesthetic vulvodynia can be challenging.
To treat neuropathic pain, the nerves need to be numbed for an extended period of time. Numbing the nerves limits the electrical signals that go through them, allowing them to gradually heal. It’s impossible for the nerves to heal while you are in pain, so getting out of pain should be the first priority in treatment. The healing process won’t happen overnight–it can take months or even years.
There are various medications that numb nerves, such as tricyclic antidepressants and anti-seizure medications. Lidocaine ointment is a topical treatment that will temporarily dull the pain.
According to Goldstein, the pelvic floor dysfunction must also be addressed. He recommends a combination of biofeedback and physical therapy to teach the muscles how to relax. Typically, the muscles of the pelvic floor cannot be voluntarily controlled, so biofeedback can teach you how to control (contract and relax) these muscles.
Common misdiagnoses The vaginal pain and redness you are experiencing could be mistaken by a doctor for a yeast infection or STD. If your doctor suspects a yeast infection, make sure that he/she performs a culture, as opposed to a simple visual exam. If you are prescribed yeast infection creams, they can further irritate the area, causing more pain and even more nerve damage. Over-prescription of yeast infection creams is actually a common cause of dysesthetic vulvodynia.
More common than a misdiagnosis, however, is no diagnosis. Doctors who are unaware of dysesthetic vulvodynia may tell you that there is nothing wrong with you. I spoken with several woman whose doctors told them that the pain was all in their heads. These women were extremely frustrated and eventually found doctors who were familiar with dysesthetic vulvodynia and how to treat it.
The links at the bottom of this article contain additional information. The book The Vulvodynia Survival Guide by Howard Glazer, Ph.D. and Gae Rodke, M.D. is also a good resource.
